How to Take Supplements

Our Q & A with Dr. Sam Russo will show you how to get the most out of your supplements

We all want to get the maximum benefit from our supplements. To help you do just that, we compiled the questions you've asked most frequently and harnessed the knowledge of Sam Russo, ND, LAc, Better Nutrition research editor and director of Vermont Naturopathic Clinic in Winooski, Vermont. Here are his answers:

1 - Which nutrients/supplements should I always take with food? Which should I take between meals?

Food should be a balanced meal that includes protein, carbohydrates, and fat to stimulate optimum acid secretion in the stomach, which enables better absorption. For example, if you eat only fruit and cereal with nonfat milk for breakfast, add some peanut butter or other protein and fat when taking the following: vitamins; minerals; oils such as fish and flax; fatty acids such as alpha lipoic acid; fatty derivatives such as plant sterols and stanols (used to lower cholesterol), and cetyl myristoleate (used to ease joint pain).

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Popular supplements that should be taken 30 minutes before or two hours after a meal include the following:

Amino acids: Although all protein contains amino acids, which are broken down during digestion, individual amino acid supplements-when taken with food-will compete with protein for absorption. Common ones include lysine for herpes; tryptophan for better sleep; cysteine to thin mucus; N-acetylcysteine (NAC), a special form of cysteine to boost internal antioxidant production and neutralize toxins; arginine to support growth hormone production and blood-pressure regulation; and branched-chain amino acids (BCAAs) for building muscles.

Herbal medicines: Bitter herbs to improve digestion should be taken with water 10 to 15 minutes before a meal. Other botanicals should usually be taken further away from meal times, as fiber in food can impair their absorption. When taking a formula, if the majority of the ingredients are botanicals, take between meals. But if vitamins and minerals predominate, take with food.

Enzymes: Timing depends on the desired benefit. To aid digestion, take enzymes at the beginning of a meal. However, systemic enzymes to treat a condition or organ, such as bromelain to reduce pain and inflammation, should be taken between meals.

2 - Which supplements are better absorbed with fat?

The fat soluble nutrients: vitamins A, D, E, K; ascorbyl palmitate, a fat-soluble form of vitamin C; and other fats and fatty derivatives (see the question above for examples). The tocopheryl acetate form of vitamin E, however, is water soluble. CoQ10 comes in fat-soluble forms, such as Q-Sorb in softgels, and as water-soluble powder in capsules, such as Q-Gel (hydrosoluble).

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3 - Is it necessary to occasionally take a vacation from your supplement routine?

There is no good evidence either way; however, some experts recommend cycling some nutrient or botanical regimens, particularly when targeting the immune system or the endocrine system. For example, you might take echinacea for one week out of each month to boost production of white blood cells that fight infection, as these cells live for about three weeks.

4 - Are there any nutrients that should always be combined? For example, I've heard that iron is better absorbed with vitamin C.

There are many ways in which nutrients influence the absorption of each other. Minerals in general are better absorbed with vitamin C or acidic foods, such as cooked tomatoes, citrus, or vinegars. This is especially true in older people, as stomach-acid production decreases with age and in anyone who takes antacids.

The chart below shows how some popular nutrients affect each other when combined. This is usually not a problem when taking high-potency multivitamin and mineral supplements, as higher doses compensate. However, if you take additional individual nutrients, it makes sense to time for optimum benefits.

These are some important points to keep in mind:

Calcium and magnesium can compete for absorption with one another in doses higher than 250 mg. When taking larger amounts, take each mineral at a different time or split doses of combinations into smaller amounts (not more than 250 mg).

Fiber supplements should be taken at a separate time from all other nutrients and herbs, as these can bind with the fiber and be excreted.

Extra Vitamin B1, taken for diabetic neuropathy, chemotherapy side effects, or other conditions, should not be taken with polyphenols (such as grape seed, pine bark, and green tea extract) because these decrease absorption of the B vitamin. Separate polyphenols and B1 by at least two hours.

Nutrient

Absorption increases when combined with

Absorption decreases when combined with

Iron

Vitamin C, protein fromanimal foods, and amino acid supplements

High doses of zinc or copper, coffee, tea, and soy

Calcium

Vitamin D (does not need to be taken at the same time), lactose (naturally present in milk and other dairy products), protein, and vitamin C

Large doses of magnesium, zinc, and phosphate

Magnesium

Vitamin D (does not need to be taken at the same time)

Large doses of calcium and phosphate

Folic acid

Vitamin C

Zinc

Niacin

Folic acid

B6

Zinc, oral contraceptives, coffee, and tobacco

B12

Vitamin C doses greater than 500 mg

Vitamin C

Pectin, iron, zinc, and aspirin

5 - Is it better to refrigerate probiotics, fish oils, and flaxseed oil? What is the general rule of thumb for refrigerating supplements?

In general or when in doubt, oils and probiotics should be refrigerated. For other supplements, a good rule of thumb is to keep them at room temperature (72°F) or below, in a dark place. Probiotics that specify "shelf-stable" or "no refrigeration required" can safely be refrigerated or kept in a cool, dark place.

6 - Why do many single-nutrient supplements have tiny amounts of another nutrient in the formula, such as calcium or vitamin C?

Reasons vary. Nutrients may be added to help absorption, as with vitamin C, and some may be helpful in other ways. For example, lecithin blends water- and fat-soluble nutrients. In other cases, additional nutrients may be incidental.

7 - Should I keep the little silica pack in my supplement bottle or throw it away? What does it do?

Keep it! The silica pack keeps the inside of the bottle dry so that your supplements don't break down as quickly. I also use those packs in my supplement pill box-great for traveling.

8 - When using powdered supplements, does it matter if I add the powder to warm or hot liquid?

In general, powder is safe to mix with liquid below 120°F (warm, not hot) if it's consumed relatively quickly. But prolonged exposure to high temperatures breaks down most water-soluble vitamins. Fat-soluble vitamins are more tolerant, and minerals are virtually indestructible. With undenatured whey protein powder, liquid above 120°F will damage naturally occurring immunoglobins that benefit the immune system.

9 - I've heard that your body can absorb only a certain amount of vitamins at a time, and therefore, it's better to stretch the dose out over the day (for example, take no more than 500 mg of vitamin C at a time). What are your thoughts?

This is true. Vitamin C and magnesium are good examples, as high doses cause loose stools, indicating you have surpassed the maximum your body can absorb. Take no more than 500 to 1,000 mg of vitamin C at one time. When taking either calcium or magnesium separately, limit each dose to 500 mg. (See question No. 1 about taking them together.)

Most water-soluble vitamins (eg., B-complex and C) and minerals do not stay in the blood stream for more than a few hours. So taking them throughout the day maximizes blood levels over a longer period.

10 - How much water should I take with my supplements and are there any that require even more water (like fiber)?

Generally, you just need enough liquid to swallow the supplement comfortably. Fiber requires more, usually at least 12 ounces per 15 grams, or 1 tablespoon. Otherwise, you can become constipated.